Allegheny Health, a member of the HealthLeaders Mastermind program on AI in revenue cycle managemet and finance operations, is using the technology to help executives understand the data and make better decisions.
Healthcare has a people problem, especially in revenue cycle management and finance operations. There just aren’t enough people filling those roles, and the competition with other industries is fierce.
This is where AI fits in.
Whereas the human touch is a critical part of clinical care, when numbers are concerned, the fewer hands the better. Revenue cycle and finance managers are looking for AI tools to reduce human interaction in areas like coding, claims, denials and prior authorizations.
“We’re all trying to remove touches from the claims process,” says Brian Ice, vice president of clinical revenue cycle for the Allegheny Health Network. “We’re all trying to come up with ways to make that process more efficient.”
“We look at AI for any workflow that's high volume [and] requires a lot of analysis,” he adds. “If it requires looking through clinical documentation or large data sets to respond. We're trying to use AI to help drive and make those workflows more efficient.”
Ice, a participant in the HealthLeaders Mastermind program on AI in revenue cycle and financial operations, says RCM and finance executives have been working with automation for years, and they’re leery of the flood of vendors coming into the space with so-called AI tools that really don’t use AI.
“Vendors that say they can do what we're looking for are a dime a dozen,” he says. “There's a lot of them out there that say they can do different things. Finding a vendor that's a good fit for your organization, that integrates well with your electronic health record, that has the right price tag associated with it,” is an elusive goal.
And what Ice is looking for now is AI that can learn the complex algorithms involved in rev cycle and finance operations and generate pathways to efficiency. Apart from transcribing documents and analyzing utilization workflows, that might mean identifying the right codes, smoothing out the prior authorization process, even predicting when a payer might issue a denial and working toward a quicker resolution.
We want to “take some of the back and forth out of it,” Ice says, adding that payers are also interested in using Ai to improve collaboration with providers.
The key, Ice says, is to have AI do the number-crunching and analysis and give RCM and finance executives the data they need to make those collaborations meaningful, whether it’s in plotting the right pathway for patients to pay their bills or working with health plans to align care management with coverage.
Ice says AI is still a new technology, and one that needs careful monitoring as it learns the workflows. Every outcome generated by an AI program still needs to be checked by the “human in the loop.”
“When you automate something, you're trying to do something at a high volume to produce a significant amount of output without human intervention,” he says. “So if you have quality issues in that space, you can create a pretty significant mess for yourself in a hurry.”
That may not always be the case, however. The hope is that AI tools in RCM and finance eventually become reliable enough to run in the background, enabling those humans in the loop to focus on other tasks.
For now, Ice says, Allegheny Health has an expansive governance team in place, representing a wide range of departments within the health system. Their tasks range from reviewing vendors and products to monitoring the development and installation of all AI programs to continuous quality control.
“There's still an extreme amount of investigation and research that goes into approving these technologies before they would ever be … deployed within our system,” he says.
The HealthLeaders Mastermind program is an exclusive series of calls and events with healthcare executives. This AI in Finance Mastermind series features ideas, solutions, and insights on excelling your AI programs.
To inquire about participating in an upcoming Mastermind series or attending a HealthLeaders Exchange event, email us at exchange@healthleadersmedia.com
The NCSBN ID can be used as a unique nurse identifier, according to the organization.
Health systems are feeling the effects off the nursing shortages as they try recruit and retain qualified nurses who want to continue being a part of the industry.
As more innovative staffing solutions arise, it's up to CNOs and other nurse leadership to take advantage of the systems and tools that are already in place to build a strong workforce.
According to Jason Schwartz, director of member outreach at the National Council of State Boards of Nursing (NCSBN), and Matt Sterzinger, director of information technology, one of those tools could be the NCSBN ID number.
The on-demand staffing model breeds loyalty and longevity, according to this CNO.
On this episode of HL Shorts, we hear from Jennifer Garnica, vice president of nursing and CNO at SSM Health St. Mary's Hospital, St. Louis, about how the W-2 on-demand staffing model is addressing staffing concerns. Tune in to hear her insights.
The NCSBN ID can be used in a central database to keep track of nurses and build the workforce, according to the NCSBN.
Amid the nursing shortage, health systems are struggling to recruit and retain qualified nurses who want to continue being a part of the industry.
Part of this equation is ensuring that nurses have career opportunities available to them and options to advance their education. While health systems can work on giving them these resources, it's also up to CNOs and other nurse leadership to take advantage of the systems and tools that are already in place to build a strong workforce.
According to Jason Schwartz, director of member outreach at the National Council of State Boards of Nursing (NCSBN), and Matt Sterzinger, director of information technology, one of those tools could be the NCSBN ID number.
What is it?
The NCSBN ID is a unique nurse identifier, according to Sterzinger, and is used exclusively in nursing. The number is issued automatically by NCSBN during the NCLEX examination process, and it follows the nurse for their entire career.
"Typically, a nurse will go to a nursing education program," Sterzinger said. "They’ll take the NCLEX exam, and then after the exam, they're licensed by a state board of nursing, and then they can begin their career as a nurse."
The information attached to the ID number has to do with the nurse that it's assigned to. According to Schwartz, nurses might have licenses in single or multiple states, and they might have different kinds of licenses. The ID is associated with all of a nurse's licensure history and disciplinary history through the state boards.
"Through our work with the state boards, all of their different nursing licenses across jurisdictions and across license types are automatically linked to the NCSBN ID from their educational institutions, employers, etc.," Schwartz said. "If they're using the NCSBN ID, they have the power then to attach even more."
The data can be found through Nursys, a national database run by NCSBN that contains all of the nurse license and disciplinary information. According to Sterzinger, NCSBN has data sharing agreements through their membership with the state boards of nursing, and they all contribute their license and disciplinary information.
"As a result, we are able to take all that license information and tie it together with one individual," Sterzinger said, "and assign that unique nurse identifier."
In terms of privacy, the NCSBN ID itself is public. Sterzinger explained that there is a subset of license and disciplinary information which is considered to be public record, and users can go to the Nursys database to find that information. Sterzinger compared the NCSBN ID to a vehicle identification number, or VIN number, on a car.
"That identifier is tied to that car, and it is connecting all these different datasets and systems around the life of that car, and it's publicly available," Sterzinger said. "You can walk up to any car, and you can look through the front windshield and down in the dashboard and you can see that VIN."
What are the benefits?
There are several use cases for the NCSBN ID, including use in education programs. According to Schwartz, the University of Alabama in Huntsville is using the ID to ensure that graduate students are maintaining active, current, and valid nursing licenses and tracking their success and their career pathways after they leave.
"With the NCSBN ID, it's possible for an education program to know what percentage of RN grads are going on to become APRNs, or what areas of the workforce they are ending up in," Schwartz said.
The ID can also be used to address workforce shortages and quantify the value of nursing. Nurses are involved in many different aspects of care delivery, Schwartz explained, but the data is captured in different systems, with no convenient way of sharing information.
"With the NCSBN ID, multiple systems can talk to each other, multiple data sets can be exchanged," Schwartz said, "but there's no personally identifying information that needs to travel."
For health systems, the NCSBN ID can help with screening and verification processes, and to make sure that nurses are keeping their licenses up to date. For CNOs specifically, Schwartz explained that the ID can be used to improve quality and training over time.
"If you're able to link the care provided by a specific nurse to a particular outcome over time, what you may find is [that] nurse is having more success than others," Schwartz said. "Are there things that that nurse is doing where we can provide training to other nurses, or perhaps if the outcomes are worse than average, is remediation or professional development needed to bring things on par with expectations?"
The NCSBN ID also provides value to the patient, according to Schwartz. Patients are able to look up their nurses and see their licenses and career history.
"Through Nursys and through the NCSBN ID, we improve upon the transparency of nursing care to the public, [and] to consumers as well," Schwartz said.
"There's a lot of studying going on regarding the nursing workforce, and aging, and where they’re coming from," Sterzinger said. "The NCSBN ID can be used to help researchers tie together different data sets and get those results so that we can make sure that we have a solid nursing workforce in the future."
Four large health systems have joined forces to launch Longitude Health. They're hoping that economy of size can overcome the barriers to innovation and actually implement value-based care.
Collaboration has become a key strategy in healthcare innovation.
The partnership aims to combine the resources of the four health systems to invest in strategies and technology that look to improve care management and coordination, health and wellness, and system improvement. A press release issued by Providence says the new group intends to make "multiple strategic investments" within two years and will invite other health systems to join them.
"Longitude Health will scale the next generation of capabilities faster and more effectively than if individual health systems attempted to do so themselves," Pete McCanna, CEO of Baylor Scott & White Health, said in the press release. "We aim to set a new standard, demonstrating that new approaches can optimize organizations performance and quality and drive positive systemic change to benefit patients."
While the announcement is short on details, it points to the idea of developing programs or deploying new technology—perhaps even spinning out new business lines--that can scale out quicker and more effectively, improving the chances of sustainability. The press release lists the organization's three main initiatives as transforming business models, improving health system performance and empowering healthier futures.
The collaboration also creates a sizable organization to work with payers on value-based care.
"Healthcare requires new approaches," David Callender, MD, Memorial Hermann's president and CEO, said in the release. "Health systems must expand their core focus areas beyond care delivery and into new business creation and services that will drive high-value care. Through this collaborative approach, we aim to take the lead in designing solutions that drive operational transformation and translate into tangible benefits for the patients and communities that we serve."
While partnerships aren't entirely new in healthcare, the idea of getting disparate health systems to work together has usually come in the form of M&A deals. Kaiser Permanente launched Risant Health in 2023 to create a value-based care network, has so far acquired Geisinger and Cone Health and plans to add another three or four health systems in the next five years. Meanwhile, Transcarent, a digital health company launched in 2020 by Glen Tullman, unveiled its "National Independent Provider Ecosystem" in 2023 with 10 health systems (including Memorial Hermann and Baylor Scott & White).
The new group's CEO is Paul Mango, a former executive at the U.S. Department of Health and Human Services (HHS) and the Center for Medicare & Medicaid Services (CMS), as well as a former partner at McKinsey and a gubernatorial candidate in Pennsylvania. The CFO is Brett Moraski, who held VP roles at Highmark Health and Wellpoint and was a founding managing partner at SEMCAP Health and operating partner at Frazier Healthcare Partners.
The CEOs of the founding health systems—McCanna, Callender, Carl Amato at Novant Health and Rod Hochman, MD, at Providence—will serve on the board of directors, with McCann as chair.
HealthLeaders Senior Editor for Innovation Eric Wicklund talks with Steff Miff, president and CEO of the Parkland Center for Clinical Innovation, about PCCI's new Community Vulnerability Compass, which helps healthcare providers identify communities facing barriers to healthcare access.
Nurses being recruited by their peers is key to the success of this staffing model, according to this CNO.
HealthLeaders spoke to Jennifer Garnica, vice president of nursing and chief nursing officer at SSM Health St. Mary's Hospital, St. Louis, about how the W-2 on-demand staffing model at SSM Health is a win-win for health systems, nurses, and patients. Tune in to hear her insights.
WellSpan Health has launched an AI agent named Ana, who's connecting with at-risk patients for screenings that might otherwise be forgotten or ignored.
Healthcare organizations are now using AI to have conversations with patients that doctors and nurses might not have time for—and closing critical population health care gaps that could save lives.
WellSpan Health launched an AI platform roughly one month ago that calls selected at-risk patients to schedule colorectal cancer screenings. The AI agent, called Ana and developed by digital health startup Hippocratic AI, asks patients if they would agree to take the test and, if they agree, arranges to mail a testing kit to their homes.
The so-called AI “agent” is designed to replace either a mailing, a cold-call program often launched out of a health system’s call center or—if the health system doesn’t have those resources—the conversation that a doctor would have with a patient during an annual checkup.
None of those tactics has a high level of success. And as a result, at-risk patients often don’t have those screenings when they should, if at all, increasing the chances of a serious health issue down the road.
WellSpan Health executives decided to use the program to reach out to patients at risk of developing colorectal cancer, identified by their birthdate and family history. Of particular concern were Spanish-speaking patients, who might miss the mailer or the conversation with a doctor because of language issues.
“It’s an opportunity for us to reach out to people in their homes, in their own time, and have a conversation with them that we maybe couldn't staff with a human,” says R. Hal Baker, WellSpan’s SVP and chief digital and innovation officer. “But [with] the right AI, that conversation could be had.”
R. Hal Baker, SVP and chief digital and innovation officer at WellSpan Health. Photo courtesy WellSpan Health.
Baker, a primary care physician, says the program takes pressure off of doctors to fit that task into an already busy care visit and gives them more time to make that visit meaningful.
“Most of my visits are 20 minutes,” he notes. “And while it may take only 30 seconds to have a conversation about colorectal cancer screening, … if I can take any of these things like mammograms and colorectal cancer screening and COVID shots and flu shots out of the visit, and they can happen reliably outside of coming to the office, that gives me more time to discuss what can only be discussed in the exam room.”
Kasey Paulus, MBA, RN, CENP, WellSpan’s SVP and chief nursing executive, says Ana works because she’s designed to be empathetic and engaging. And she can speak Spanish, in which not many doctors or nurses are fluent.
“A sensitive AI that speaks your language [is better than] a well-meaning human who can’t speak Spanish,” Baker says.
And it works. Of the first 455 Spanish-speaking patients contacted by Ana, 15% agreed to screening, Baker says, and the net promoter score was higher than that of English-speaking patients (of which 6% agreed to a screening).
“Not bad for an automated reach-out cold call to people who weren’t expecting it,” he says.
Kasey Paulus, MBA, RN, CENP, SVP and chief nursing executive at WellSpan Health. Photo courtesy WellSpan Health.
Eventually, the health system will see results in clinical outcomes. More screenings will lead to more cancers detected and treated early, improving the quality of life for patients and reducing deaths. Financially, more screenings might boost initial costs but lead to less expensive medical treatments and long-term care later on.
Baker and Paulus say WellSpan worked closely with Hippocratic AI to develop Ana, going through every scenario that the AI agent would face and every question that a patient might ask. Baker says he even tried to confuse Ana during a test by announcing that his birthday was on New Year’s Day.
“We have a very creative and collaborative multidisciplinary team, and those individuals do their best to try to break it before we launch it,” he says. “So we're looking for ways [in which] somebody might trip it up that we didn't even think of, because inevitably that will happen.”
For example, Baker says, “We had to very quickly realize we had needed to add the ability for somebody to say, ‘Please don't call me again.’ “
In launching Ana, Baker says the health system was very careful to make sure that patients know they’re talking to an AI agent. For the first 100 phone calls, a nurse was also on the line to make sure things ran smoothly.
“What we found out was that [the nurse] didn’t have to” be in on the call, he says. “What is novel here is that we have now moved the human in the loop to the human on the tail for our next thousand calls,” meaning a nurse will review the call within a few hours.
With the platform now up and running, Baker and Paulus say they’re giving Ana another task: connecting with patients who are coming into WellSpan for a colonoscopy. Ana will call them ahead of that appointment and go through everything the patient needs to do before the procedure. Again, that task would have been handled by a nurse or call center, if at all.
“The last 48 hours of coaching are really critical,” Paulus says. “And AI can help us where we can't always have somebody on call 24/7 365.”
She says the health system will see the benefits in reduced cancellations and procedures that are started and cut short or unsuccessful.
Baker says the platform may scale up in time as WellSpan explores how Ana can effectively interact with patients and support their healthcare journey. They may use the platform for more population health outreach, or to help patients prepare for other procedures, or even to check up on them and coordinate care after a procedure.
“We recognize that we're boldly going into some uncharted territory and that our AI is not replacing our clinical staff but augmenting the work that they just don't have the capacity to do,” he says.
There has been a generational shift in what to expect from nursing as a profession, according to this CNE.
On this episode of HL Shorts, we hear from Melanie Heuston, chief nurse executive at WVU Medicine, and HealthLeaders Exchange member, about what new graduate nurses are expecting from the job in 2024. Tune in to hear her insights.
The HealthLeaders Exchange is an exclusive, executive community for sharing ideas, solutions, and insights.
Hear more about how nurses and nurse leaders can help patients engage with their healthcare, in and out of the hospital.
Nurses wear many hats in the industry, but their primary focus is on patient interaction and care delivery.
Both nurses and nurse leaders play pivotal roles in making sure that patients engage with preventative care measures and patient education programs. It's also the CNO's job to ensure the effectiveness of remote patient monitoring programs and to find creative solutions for dealing with social determinants of health.
According to Cassie Lewis, chief nursing officer at Bon Secours’ Richmond market, part of Bon Secours Mercy Health, and HealthLeaders Exchange member, improving patient engagement begins with the day-to-day interactions between the patient and the bedside nurses who care for them.
"Those subtle interactions that they can do with our patients everyday can truly make such a difference in how patients view our healthcare system and how they view their care," Lewis said. "Trying to emphasize this for our teams and making sure…they understand the importance and what they can do for our patients is the first step in helping them engage in a more meaningful way."
Building trust and communication between nurses and patients is also critical to patient engagement, according to Lewis.
"One solution that we have really tried to emphasize here is the importance of bedside shift reports and good handoffs," Lewis said. "It's really important to start developing trust with the patients and including them in their care, versus keeping them on the outside looking in."
Lewis recommended that CNOs leverage technology to build robust, individualized patient education and remote patient monitoring programs, while considering social determinants of health. Clinical nurse specialists, nurse practitioners, and nurse educators all play a key role in these processes.
"We know that it's not a one-stop shop for every single patient that comes in our door," Lewis said, "and while we have great things we can augment with technology […], [we need] to take that one step further."
Listen to this week's episode of the HealthLeaders Podcast to hear more about how nurses and nurse leaders can help patients engage with their healthcare, in and out of the hospital.
